Lead Order Form

Mailer Format

Type of Mailer(Required)

Mailer Piece Code

Lead Delivery Method(Required)

Demographics

If you ran your own count, enter query number:

OR fill out demographics below

Age

Date of Birth

Income Range

Omit PO Boxes

Other

ZipCodes, SCF, County and/or States:

Order Quantities

Number to Mail(Required)

Total Cost

If quantity is 500-999, add $50 flat set up fee. If under 500, add $100 set up. Does not include shipping/handling or tax for TX orders. Cost per thousand and final cost are subject to change.

Duplicate List Options

8 1/2 X 11 Printed List $25/M

Email List in Excel or CSV $25/M

Labels $25/M

Additional Options

Print Phone #'s (where available) on card - $10/M

Street Sequence on duplicate list - $3/M

Print DOB month/year on duplicate list - $20/M

Select Homeowners Only - $10/M

Select by Gender - $3/M

Notes and Special Instructions

Notes and Instructions

Billing and/or Shipping Address

Company name

Email(Required)

Name(Required)

First Last

Address

Street Address Address Line 2 City State ZIP Code

Pay By(Required)

Note: We will contact you for card information. Order is subject to zip code availability under our 90 day file protection policy